Appendix F
MNCM/Stratis Health Brief: Cross-Setting Ambulatory and
Hospital, and Patient Safety Measurement
RE: Cross-Setting Ambulatory and Hospital, and Patient Safety Measurement
MN Community Measurement (MNCM) and Stratis Health are pleased to provide follow-up to
our conversation and e-mails on the topics of Cross-Setting Ambulatory and Hospital
Measurement and a Composite or Index Patient Safety Measurement. MNCM and Stratis Health
have a long history of working together. Together, we believe we can create measures that are
impactful and meaningful. This letter provides information on the importance of these proposed
new directions in measurement, as well as how the work would be accomplished through our
continued partnership.
Continued Coordinated Partnership
MNCM and Stratis Health are unique organizations that leverage organizational expertise and
stakeholder networks to maximize community participation and support. Specifically, MNCM’s
knowledge of the measure development process, measurement landscape, characteristics of
strong measurement and potential barriers to community acceptance, are critical considerations
in successful development and testing. Stratis Health’s expertise in the area of quality
improvement, patient safety, experience using measurement and evidence-based practices to
develop improvement projects informs the feasibility and usability of any measure under
consideration. Both organizations have oversight committees.
Cross-Setting Measurement: Ambulatory and Hospital Measures
Why Measure?
Quality measurement in health care initially developed over the past decade with setting-specific
measures, such as measures specific to acute care or ambulatory care. However, measurement
needs have evolved in recent years to accommodate new approaches to care delivery. Measures
are needed today which are more comprehensive and patient-centered, extend across the
continuum of care, and support new payment models that incorporate Total Cost of Care and
Accountable Care contracts. The emerging care delivery and payment models are beginning to
encompass population health and to help address health equity.
Stratis Health | www.stratishealth.org
65
The State of Minnesota, through the Statewide Quality Reporting & Measurement System
(SQRMS) program, reports on a portfolio of hospital and clinic measures, and should continue to
do so to help support a culture of transparency and quality. In addition, there is an opportunity
and need to add to SQRMS reporting joint or coordinated measures across the continuum of care
(“cross-cutting measures”) in response to the changing care delivery and payment environment.
Priorities identified by MNCM and Stratis Health, in their quality measurement work with multistakeholder groups, include cross-cutting measures in care transitions, advance care planning and
time-critical care. These are areas prime for cross-cutting measurement in Minnesota, building
on the RARE Campaign for care transitions, the work of Honoring Choices Minnesota and the
Health Care Homes program for advance care planning and AHA Mission Lifeline and the MN
Stroke Registry. These areas also reflect National Quality Strategy and CMS measurement
priorities.
Patient Safety Composite or Index
Why Measure?
Patient safety consistently emerges as a high priority for both health care delivery organizations
and for patients and families. There are many hospital safety measures currently reported at a
state and national level, yet they do not provide a comprehensive picture of how safe care is at a
hospital or health system; nor do today’s clinical safety measures reflect the growing body of
research related to organizational properties and systems which are essential for safety. Today’s
measures tend to be condition-specific or harm-specific (e.g., surgical site infection, falls,
sepsis), and do not include how reliable a hospital’s care is, or whether the culture is set up for
reliability and learning.
To make patient safety hospital measurement meaningful and comprehensive, and more
understandable to consumers, SQRMS could build upon the reporting individual hospital safety
measures with reporting of a multi-faceted patient safety index or composite measure. The index
or composite could include a balanced set of process, outcome, and structural measures and can
be derived from existing measures and indices and put together in a combination to meet
community needs. This aligns with the national measures from CMS and also aligns with suite,
composite and/or outcomes measurement that MN Community Measurement has developed in
the ambulatory setting.
How We Partner
MNCM and Stratis Health currently partner in a variety of ways. For the development of
measures, we would collaborate utilizing Stratis Health’s extensive knowledge of hospital-based
measurement and MNCM’s experience with successful measure development and
implementation. This includes MNCM providing guidance regarding the important measure
development factors for consideration and Stratis Health providing hospital-based priorities
when developing a new measure concept. MNCM’s established measure development process
would be utilized with Stratis Health and MNCM co-facilitating. Per the MNCM measure
development process, an external chairperson with clinical expertise would be selected for the
workgroups. Since attribution will be hospital, clinic or other provider based, both the Stratis
Health Hospital Quality Reporting Steering Committee (HQRSC) and MNCM’s Measurement
Stratis Health | www.stratishealth.org
66
and Reporting Committee (MARC) would be utilized to solicit stakeholder feedback and
approval of the measures concepts. For both the Cross Setting and Safety Composite or Index
Measure, a measure concept (which draws upon existing measures in developing a new
composite or index) would be brought to the Committees, workgroups formed, methodology
developed and agreed upon and then the measure tested. The entire measure development
process would take approximately 18 to 24 months.
Feasibility
In an environment of constrained resources, the measurement directions recommended above are
feasible if some of the current reporting is simplified. Specifically, the Stratis Health team has
suggested moving to a hospital reporting framework which reports two existing measure sets –
the CMS Value-Based Purchasing (VBP Total Performance Score) for PPS hospitals and the
HRSA Medicare Beneficiary Quality Improvement Project (MBQIP) set of measures for CAH
hospital. By utilizing this pair of comprehensive national measures, time and resources are
available to pursue the cross-setting and safety composite measures recommended.
This approach for hospitals would not have been possible even just a couple of years ago, but is
today. The CMS VBP Total Performance Score is a single number reflective of a combination
of process measures, outcome measures, patient experience of care measures, and efficiency/cost
measures. The process and patient experience are both all payer measures, while the outcome
and cost measures are Medicare-specific. There is wide variation in the Total Performance Score
of Minnesota’s 50 PPS hospitals, which indicates room for improvement and distinction between
them.
For the Total Performance Score and the MBQIP measures, some up front design work would be
required but no additional or separate data collection would be required since it is all already
done by CMS or the State flex coordinator at MDH. SQRMS could add some additional analysis
to the public report as well, showing the variation across hospitals and the comparison to both
MN and national results. Similarly, MBQIP for critical access hospitals includes a balanced mix
of measures relevant to rural small volume facilities.
In total, all this activity can occur and can continue in a coordinated way as we have for several
years for MDH with Stratis as a subcontractor to MNCM through its Health Care Quality
Measurement contract.
In conclusion, we believe that together we can create measures in these arenas that are
meaningful and impactful. We look forward to your thoughts and future discussion.
Stratis Health | www.stratishealth.org
67